Technical challenges of penetrating keratoplasty in central corneal dystrophy associated with a peripheral corneal lesion

Session Details

Session Title: Presented Poster Session: Cornea: Surgical

Venue: Poster Village: Pod 3

First Author: : M.Zemba ROMANIA

Co Author(s): :    A. Stamate                       

Abstract Details

Purpose:

To present the diagnostic and therapeutic difficulties in a case of central corneal dystrophy associated with a peripheral corneal lesion.

Setting:

Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania.

Methods:

History: a 48-year-old male patient was referred to our clinic for bilateral decreased visual acuity (VA): OD: CF at 1 meter, OS: 0.1 SC NC; Biomicroscopy: OD: central discoid corneal opacity of 6/5 mm with polychromatic refractile crystals, particularly in the center; superiorly, between 10 and 14 o’clock, a lesion located 3 mm away from the limbus, with fine corneal neovessels from the limbus to the edge of the lesion; OS: central discoid opacity less intense than in OD, similar size, with less obvious polychromatic refractile crystals; Ultrasound biomicroscopy and anterior segment OCT were performed.

Results:

Evaluating the history, clinical aspects and anterior segment imaging, the diagnosis was OU: Stromal corneal dystrophy - type Schnyder, OD: Peripheral corneal degeneration, and penetrating keratoplasty in OD was performed. Possible surgical complications: suturing in the area of upper peripheral degeneration, not knowing the influence of the host's corneal astigmatism on the lesion, not knowing the outcome of the lesion, possibly irritated by the sutures. Postoperative evolution: day 4: VA OD: 0.2 SC and 3 months: VA OD: 0.4 SC with transparent cornea and lens, and normal fundus examination. Pathology report: confirmed the diagnosis.

Conclusions:

- the association of central and peripheral corneal lesions raised issues concerning the technique of corneal transplant, - preoperative investigations (ultrasound biomicroscopy and anterior segment optical coherence tomography) that did not show a thinned cornea in the peripheral degeneration area allowed transplant to be carried out without its decentration, - histopathological findings, that rather showed a healing process and a favorable evolution in the mean term, entitled us to hope for a good prognosis.

Financial Disclosure:

None